Definition

The age-adjusted rate of deaths resulting from the intentional use of force against oneself among those aged 25 and older. Suicide mortality rate is defined as the number of resident deaths resulting from the intentional use of force against oneself per 100,000 population for the age group, in this case ages 25 and older, age-adjusted to the 2000 standard population. The definition of suicide is "death arising from an act inflicted upon oneself with the intent to kill oneself." ICD-9 codes: E950-E959. ICD-10 codes: *U03, X60-X84, Y87.0.

Numerator

Number of deaths of individuals 25 and older resulting from the intentional use of force against oneself.

Denominator

Mid-year resident population aged 25 and older for the same calendar year.

Data Interpretation Issues

Alaska populations are from the [http://laborstats.alaska.gov/pop/popest.htm Alaska Department of Labor and Workforce Development, Research and Analysis].

Why Is This Important?

The rate of suicide is increasing in America. Now the 10th leading cause of death, suicide claims more lives than traffic accidents
and more than twice as many homicides.^1^
The economic and human cost of suicidal behavior to individuals, families, communities and society makes suicide a serious public
health problem. Alaska had the second highest age-adjusted suicide rate in the nation in 2014 at 22.1, the most recent year for
which national data are currently available.^2^
Suicide cost Alaska a total of $226,875,000 of combined lifetime medical and work lost cost in 2010, or an average of $1,383,382
per suicide death.^3^[[br]]
[[br]]
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{{class .SmallerFont
1. The Joint Commission. Detecting and treating suicide ideation in all settings. [https://www.jointcommission.org/sea_issue_56/]. Published February 24, 2016. Accessed October 11, 2016.
2. U.S. Centers for Disease Control and Prevention (CDC). Suicide mortality by state: 2014. [http://www.cdc.gov/nchs/pressroom/sosmap/suicide-mortality/suicide.htm]. Accessed October 5, 2016.
3. American Foundation for Suicide Prevention. State fact sheets: suicide: Alaska 2016 facts & figures. [https://afsp.org/about-suicide/state-fact-sheets/#Alaska]. Accessed October 5, 2016.
}}

Other Objectives

Healthy Alaskans 2020 Indicator 7.b: Reduce the suicide mortality rate of adults 25 years and older to 23.5 per 100,000 by 2020.
'''Who is at risk for suicide?'''
Much of what we know about the profile of individuals who have died by suicide and those who have attempted suicide comes from looking in the rearview mirror - at data compiled about suicide victims and attempts. Suicide may affect certain demographics - such as military veterans and men over age 45 - more than others. It's important to identify the risk factors, rather than membership in a group, when considering suicide risk. Paying attention to risk factors matters because patients may not disclose suicide ideation voluntarily. Risk factors for suicide include:
* Mental or emotional disorders, particularly depression and bipolar disorder. Up to 90 percent of suicide victims suffer from a mental or emotional disorder at the time of death.
* Previous suicide attempts or self-inflicted injury; the risk of suicide is twice as high (100 percent higher) than general suicide rates for one year following a suicide attempt and the higher risk continues beyond that. The risk is even higher the first few weeks immediately following a suicide attempt.
* History of trauma or loss, such as abuse as a child, a family history of suicide, bereavement or economic loss.
* Serious illness, or physical or chronic pain or impairment.
* Alcohol and drug abuse.
* Social isolation or a pattern/history of aggressive or antisocial behavior.
* Discharge from inpatient psychiatric care, within the first year after and particularly within the first weeks and months after discharge. While some depressed patients who attempt or die by suicide after inpatient psychiatric hospitalization express suicide ideation before or during hospitalization, other depressed patients who have received inpatient psychiatric treatment develop suicide ideation after discharge.
* Access to lethal means coupled with suicidal thoughts.
However, there is no typical suicide victim. Most individuals having these risk factors do not attempt suicide, and others without these conditions sometimes do. Therefore, there is a danger in considering only individuals with certain conditions or experiences in certain settings as being at risk for suicide. It's imperative for everyone in all settings to better detect suicide ideation in others, and to take appropriate steps for their safety and/or refer these individuals to an appropriate provider for screening, risk assessment, and treatment.^1^[[br]]
[[br]]
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{{class .SmallerFont
1. The Joint Commission. Detecting and treating suicide ideation in all settings. [https://www.jointcommission.org/sea_issue_56/]. Published February 24, 2016. Accessed October 11, 2016.
}}

How Are We Doing?

In 2017, the suicide mortality rate for all Alaskans aged 25+ years was 31.1 per 100,000. The rate for Alaska Native people 25+ years was 57.3 per 100,000 in 2017. The trend for all Alaskans aged 25+ years appears to be trending upward as of 2001. The suicide rate for Alaskan adults 25+ years remains higher than the Healthy Alaskans 2020 goal of 23.5 per 100,000. Rates were consistently higher among males than females during 1990-2017, and the Y-K Delta had rates higher than all but the Northwest region during 2013-2017 combined.

How Do We Compare With the U.S.?

The national suicide mortality rate for adults 25+ in 2016 (the most recent year for which national data were available) was 17.8 per 100,000.^5^ Compared to the national average for this age
group, the rate for all Alaskans was over 50% higher at 27.9 per 100,000 and over double for Alaska Natives at 41.6 per 100,000 in
2016.[[br]]
[[br]]
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{{class .SmallerFont
5. Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 1999-2017 on CDC WONDER Online Database, released December, 2018. [http://wonder.cdc.gov/ucd-icd10.html]. Accessed January 1, 2019.
}}

What Is Being Done?

The Statewide Suicide Prevention Council [http://dhss.alaska.gov/suicideprevention/Pages/default.aspx ] advises the governor and legislature on issues relating to suicide. In collaboration with communities, faith-based organizations, and public-private entities, the Council works to improve the health and wellness of Alaskans by reducing suicide and its effect on individuals and communities.

Evidence-based Practices

Public health partners around the state are aligning work around these approaches adapted to Alaska's unique needs. Below are the strategies identified for enhancing mental health support systems.
'''Strategy 1:'''
[[br]]Create supportive environments that promote resilient, healthy, and empowered individuals, families, schools, and communities (universal prevention).
'''Evidence Base:'''
[[br]]The World Health Organization holds that "a supportive environment is of paramount importance for health. The two are interdependent and inseparable" (Sundsvall Statement on Supportive Environments for Health, 1991). Supportive environments can help protect people from risk factors for poor health, encourage participation in health care and health promotion, expand individuals' health competencies and self-reliance, and support person-centered health care. Stigma and attitudes about help-seeking (specifically seeking treatment or services for mental health conditions) are key barriers to promoting mental and emotional health and preventing mental illness. Creating communities that de-stigmatize depression and mental illness and encourage people to seek mental health services when needed can increase the number of people accessing services.
'''Sources:'''
[[br]]Segal DL, Coolidge FL, Mincic MS, O'Riley A. Beliefs about mental illness and willingness to seek help: a cross-sectional study. Aging Ment Health 2005;9(4):363-7.
Reynders A, Kerkhof AJFM, Molenberghs G, Van Audenhove C. Attitudes and stigma in relation to help-seeking intentions for psychological problems in low and high suicide rate regions. Social Psychiatry and Psychiatric Epidemiology 2014;49(2): 231-9.
'''Strategy 2:'''
[[br]]Enhance clinical and community preventive services to ensure availability of timely treatment and support services (indicated prevention).
'''Evidence Base:'''
[[br]]Nearly half of individuals who die by suicide had a diagnosable mental health disorder. Timely access to appropriate mental health and substance use disorder treatment services as close to home as possible is essential to preventing suicide. Not all behavioral health professions provide or require suicide-specific education for licensure. Yet, outpatient and community behavioral health providers often provide services to individuals at risk of suicide and so are in a position to help prevent suicide. Evidence-based training that strengthens clinical competencies to address suicide risk and ideation can reduce suicide among people receiving behavioral health services.
Primary and specialty health care providers also have a role to play in suicide prevention. Appropriate assessment and referral for services is needed in a variety of health care settings. Integrating behavioral health care with primary care can help ensure timely access to appropriate services, especially for patients experiencing mental health disorders. For example, the Community Preventive Services Task Force, DHHS recommends collaborative care for the management of depressive disorders.
'''Sources:'''
[[br]]National Research Council. Reducing Suicide: A National Imperative. Washington, DC: The National Academies Press, 2002.
Recommendation from the Community Preventive Services Task Force for Use of Collaborative Care for the Management of Depressive Disorders[http://www.thecommunityguide.org/mentalhealth/CollabCare_Recommendation.pdf]
'''Strategy 3:'''
[[br]]Allocate resources to suicide prevention efforts proven effective through evidence based on surveillance, research, and evaluation.
'''Evidence Base:'''
[[br]]Prioritizing funding for evidence-based suicide prevention practices helps to ensure that limited public resources are used to the maximum benefit of communities.
'''Source:'''
[[br]] National Registry of Evidence Based Programs and Practices (NREPP) [http://www.nrepp.samhsa.gov]

Health Program Information

Casting the Net Upstream Goals^6^:
[[br]]Goal 1. Alaskans accept responsibility for preventing suicide.
[[br]]Goal 2. Alaskans effectively and appropriately respond to people at risk of suicide.
[[br]]Goal 3. Alaskans communicate, cooperate, and coordinate suicide prevention efforts.
[[br]]Goal 4. Alaskans have immediate access to the prevention, treatment, and recovery services they need.
[[br]]Goal 5. Alaskans support survivors in healing.
[[br]]Goal 6. Quality data and research is available and used for planning, implementation, and evaluation of suicide prevention efforts.
The Joint Commission urges all health care organizations to develop clinical environment readiness by identifying, developing, and integrating comprehensive behavioral health, primary care, and community resources to assure continuity of care for individuals at risk for suicide. Many communities and health care organizations presently do not have adequate suicide prevention resources, leading to the low detection and treatment rate of those at risk. As a result, providers who do identify patients at risk for suicide often must interrupt their workflow and disrupt their schedule for the day to find treatment and assure safety for these patients.^1^
'''Detecting suicide ideation in non-acute or acute care setting'''
1. Review each patient's personal and family medical history for suicide risk factors.
2. Screen all patients for suicide ideation, using a brief, standardized, evidence-based screening tool.
3. Review screening questionnaires before the patient leaves the appointment or is discharged.
'''Taking immediate action and safety planning'''
4. Take the following actions, using assessment results to inform the level of safety measures needed.
'''Behavioral health treatment and discharge'''
5. Establish a collaborative, ongoing, and systematic assessment and treatment process with the patient involving the patient's other providers, family and friends as appropriate.
6. To improve outcomes for at-risk patients, develop treatment and discharge plans that directly target suicidality.
'''Education and documentation'''
7. Educate all staff in patient care settings about how to identify and respond to patients with suicide ideation.
8. Document decisions regarding the care and referral of patients with suicide risk.
[[br]]
[[br]]
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{{class .SmallerFont
1. The Joint Commission. Detecting and treating suicide ideation in all settings. [https://www.jointcommission.org/sea_issue_56/]. Published February 24, 2016. Accessed October 11, 2016.
6. Casting the net upstream: promoting wellness to prevent suicide. Alaska State Suicide Prevention Plan, 2012-2017. Annual Implementation Report 2014. [http://dhss.alaska.gov/SuicidePrevention/Documents/pdfs_sspc/CTN2014-Implementation.pdf]. Accessed October 11, 2016.
}}

Data Notes

** Data not available
Data for Alaska Natives from 1996, 2001, and 2003 are based upon fewer than 20 occurrences and are considered statistically unreliable. These data should be used with caution.
Alaska Native people refers to any mention of American Indian or Alaska Native heritage when enumerating racial and ethnic background. Individuals of multiple races incorporating American Indian/Alaska Native are moved into the Alaska Native group. When race and ethnicity are consider concurrently, Hispanic individuals with American Indian/Alaska Native heritage are combined into the Alaska Native (any mention) group and removed from the Hispanic class.
The definition of the Alaska Native group is intended to conform to the eligibility requirements for access to Alaska Native Tribal Health Consortium.

Data Sources

[http://dhss.alaska.gov/dph/VitalStats/Pages/default.aspx Health Analytics and Vital Records Section (HAVRS)], Division of Public Health, Alaska Department of Health and Social Services

National Center for Injury Prevention and Control's Web-based Injury Statistics Query and Reporting System (WISQARS)

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